Provider Demographics
NPI:1841024742
Name:JEREMY MARTENS DMD PLLC
Entity type:Organization
Organization Name:JEREMY MARTENS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-726-2762
Mailing Address - Street 1:313 NW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4317
Mailing Address - Country:US
Mailing Address - Phone:707-326-9465
Mailing Address - Fax:
Practice Address - Street 1:1706 W MAIN ST STE 117
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4320
Practice Address - Country:US
Practice Address - Phone:360-726-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty